Legalizing physician-assisted suicide is a part of the debate about improving end-of-life care. It can't be seen as a quick and easy way to protect patients from inadequate care arrangements. Too many people still suffer needlessly, often because doctors and families just do not know how to serve people who are dying. Many suffer because doctors fail to provide adequate medication for pain. To legalize physician-assisted suicide, some believe, would make real reform, such as better pain control, less likely. Without those reforms, patients end up with no prospects to live well while dying. In this scenario, making suicide an option is not offering a genuine choice.

Many people fear that physician-assisted suicide will create a climate in which some people are pressured into committing suicide. The very old, the very poor, or minorities and other vulnerable populations might be encouraged to hasten death, rather than to "burden" their families or the health care system. Again, this is not a genuine choice, but a social issue, one that stems from how our society cares for its elders and for the poor, and whether minority groups can get good health care. In either case, making suicide available does not solve the underlying social problem. Even for those who have adequate financial and social resources, having physician-assisted suicide available could create a troubling new situation. Seriously ill and disabled persons could feel that they had to justify a choice to stay alive. They could feel that suicide is, in some sense, "expected" by family or friends. As a society, we have never asked people to justify their being alive, and it seems likely that asking them to do so would run risks of being quite difficult or demeaning.

Finally the safeguards built into the proposed statutes will be very difficult to implement. "Terminal illness," "competent" patients, and "voluntary action" are each very ambiguous categories. Waiting times and restrictions on the help avail-able are likely to create tragic situations that push public opinion toward loosening restrictions.

A 1997 study conducted by the American Medical Association (AMA) found that more than half of Americans believe physician-assisted suicide should be legal. However, when people are told about alternatives to the technological treatments so many of us fear, and about the availability of pain control and hospice care, their support for physician-assisted suicide goes down to under one-fifth. This study seems to show that when people are informed about all of their end-of-life choices, they are less likely to opt for suicide.